We assessed the clonality of consecutive Escherichia coli isolates during the course of recurrent urinary tract infections (RUTI) in childhood in order to compare clonality with phenotypic antibiotic resistance patterns, the presence of integrons, and the presence of the sul1, sul2, and sul3 genes. Altogether, 78 urinary E. coli isolates from 27 children, who experienced recurrences during a 1-year follow-up after the first attack of acute pyelonephritis, were investigated. The MICs of sulfamethoxazole, trimethoprim-sulfamethoxazole (SXT), ampicillin, cefuroxime, cefotaxime, and gentamicin and the presence or absence of the intI gene for class 1 integrons and the sulfamethoxazole resistance-encoding genes sul1, sul2, and sul3 were determined. All E. coli strains were genotyped by pulsed-field gel electrophoresis. There were no significant differences in the prevalences of resistance to beta-lactams and SXT between initial and consecutive E. coli isolates (41 versus 45% and 41 versus 29%, respectively). However, the E. coli strains obtained after SXT administration more frequently carried two or more sul genes than the nonexposed strains (9/21 [43%] versus 11/57 [19%], respectively; P ؍ 0.044). In 78% of the patients, the recurrence of unique clonal E. coli strains alone or combined with individual strains was detected. Phenotypic resistance and the occurrence of sul genes were more stable in clonal strains than in individual strains (odds ratios, 8.7 [95% confidence interval {95% CI}, 1.8 to 40.8] and 4.4 [95% CI, 1.1 to 17.7], respectively). Thus, in children with RUTIs, the majority of E. coli strains from consecutive episodes are unique persisting clones, with rare increases in the initially high antimicrobial resistance, the presence of sul genes, and the presence of integrons.Persistent urinary tract infections usually emerge in early childhood. Approximately 1 to 8% of children between the ages of 1 month and 11 years have experienced at least one urinary tract infection (23,31,41,42). Recurrent urinary tract infection (RUTI) endangers renal function; even the first episode of acute pyelonephritis can lead to renal scarring in 9.5% to 57% of cases, according to Hoberman et al. (17) and Lin et al. (34), respectively. In childhood the most important risk factor for RUTI has been considered to be the presence of vesicourinary reflux, alone or combined with dysfunctional voiding (3,49,58).The second important risk factor is closely associated with antimicrobial therapy for RUTI. In children, as in adults, the most frequent urinary pathogen is Escherichia coli, and the prevailing treatment schemes include the beta-lactam antibiotics, trimethoprim-sulfamethoxazole (SXT), and aminoglycosides (1, 25). However, increased resistance among urinary E. coli strains to some beta-lactam antibiotics and SXT has been reported in different countries (18,27). Furthermore, children with vesicourinary reflux require long-term antimicrobial prophylaxis (20, 39), usually with SXT or nitrofurantoin. This, in turn, can select ...